We analyzed the serum concentrations of lipids and lipoproteins and the prevalence of other risk factors in a case-control study of 304 consecutive Chinese patients with acute stroke (classified as cerebral infarction, lacunar infarction, or intracerebral hemorrhage) and 304 age-and sex-matched controls. For all strokes we identified the following risk factors: a history of ischemic heart disease, diabetes mellitus, or hypertension; the presence of atrial fibrillation or left ventricular hypertrophy; a glycosylated hemoglobin A, concentration of >9.1%; a fasting plasma glucose concentration 3 months after stroke of >6.0 mmol/1; a serum triglyceride concentration 3 months after stroke of >2.1 mmol/1; and a serum lipoprotein(a) concentration of >29.2 mg/dl. We found the following protective factors: a serum high density lipoproteincholesterol concentration of >1.59 mmol/1 and a serum apolipoprotein A-I concentration of a 106 mg/dl. The patterns of risk factors differed among the three stroke subtypes. When significant risk factors were entered into a multiple logistic regression model, we found a history of hypertension, a high serum lipoprotein(a) concentration, and a low apolipoprotein A-I concentration to be independent risk factors for all strokes. The attributable risk for hypertension was estimated to be 24% in patients aged >60 years. In this population, in which cerebrovascular diseases are the third commonest cause of mortality, identification of risk factors will allow further studies in risk factor modification for the prevention of stroke. (Stroke 1991;22:203-208) R isk factors for cerebrovascular diseases have been studied extensively in Caucasian and Japanese populations. 1 " 6 However, there are few studies examining apolipoproteins as risk factors. Also, there are few stroke studies among Chinese populations. No longitudinal or case-control studies of risk factors have been reported, few studies provide classification of stroke subtypes by computed tomography (CT), and the role of lipids and lipoproteins has not been investigated systematically. In this case-control study, we examined the serum concentrations of lipids, lipoproteins, and apolipoproteins and the prevalence of other risk factors in Chinese subjects with different stroke subtypes and estimated the attributable risks of some common risk factors for the Chinese population in Hong Kong.
The Shatin Stroke Registry is a prospective study of all patients admitted with acute stroke to a general hospital in Hong Kong where the population is predominantly Chinese. Each patient was examined by a neurologist and 95.5% of the patients had a brain CT. Of 777 patients included in the study, 44.0% had a cortical/subcortical infarct, 18.5% a supratentorial lacunar infarct, 24.2% a supratentorial intracerebral hemorrhage, 5.8% brainstem/cerebellar infarct, 2.9% a brainstem/cerebellar hemorrhage, and 4.5% an uncertain diagnosis. The overall 30-day case fatality rate was 25.4%. Comparison with five stroke registries from the West suggests that intracerebral hemorrhage occurs between two and three times more frequently in the Chinese than in Westerners. Whether there is any difference in the relative frequencies for lacunar infarction remains unclear.
We studied serum lipid profiles in 171 patients <48 hours after the onset of acute stroke and 3 months later. The 83 patients suffering cerebral infarction had significantly higher serum concentrations of total cholesterol, low density lipoprotein-cholesterol, and apolipoprotein B and significantly lower serum concentrations of triglycerides and lipoprotein (a) <48 hours after ictus than 3 months later. The lipid profiles of the 53 patients suffering lacunar infarction were similar on both occasions, the only significant differences being higher total cholesterol and low density lipoprotein-cholesterol concentrations <48 hours after ictus. No significant changes were observed among the 35 patients suffering cerebral hemorrhage apart from a significantly higher concentration of high density Hpoprotein 3 -cholesterol <48 hours after ictus. Our study, with many patients classified according to stroke subtype, gives results different from those of previous studies with much fewer patients. ) were examined, not all subtypes of stroke were denned, only men were considered in one, 2 and conflicting results were obtained. Also, there was no information given on temporal changes in the concentrations of apolipoprotein fractions or lipoprotein (a) after acute stroke, which is of particular interest since apolipoproteins may be better indicators of atherosclerosis than lipids, 3 and since lipoprotein (a) appears to be a strong indicator for cerebrovascular disease. 4 We examined the lipid profiles of patients with acute stroke classified into stroke subtypes <48 hours after ictus and repeated the profile 3 months
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